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A girl aged 3 years 6 months has neurofibromatosis with significant visual impairment and mild to moderate learning difficulties. She has always been difficult to settle to sleep and has frequent nocturnal wakenings.
A sleep programme with specific behavioural management techniques has been used, as have sedative medications such as trimeprazine, which caused deterioration in concentration and daytime sleepiness. Should she be tried on melatonin?
Structured clinical question
In a preschool child with visual impairment and mild to moderate learning difficulties, in whom conventional treatments have failed [patient] is melatonin [intervention] likely to improve her sleep pattern …